Fascial manipulation© (FM) is a manual therapy method specifically designed to address restrictions and densifications of the deep fascia tissue that surrounds and interconnects muscles, tendons, bones, nerves, blood vessels and internal organs throughout the body. Restrictions in the gliding and sliding ability of separate facial layers of connective tissue due to overuse, trauma or immobilization contribute to densifications. This means that the dysfunctional tissue at specific points within the human body feels denser when felt and it has also been shown to have increased thickness on ultrasound imaging (Stecco et al. 2014; Luomala T, et al. 2014). These densifications often change the direction of the way muscles and tendons pull. The mechanics of the joints are then compromised causing acute and chronic pain and further injury of the musculoskeletal system.
What Is Fascia and What Is Its Function?
Fascia is a structure of connective tissue that surrounds and interconnects muscles, groups of muscles, bones, nerves and internal organs. Fascia is also part of the nervous system. It has many nerve endings and receptors, making it very suitable to detect variations in tissue tension caused by any movement in the human body. It perceives these movements through adaptations in fascial tension and it also assists in the execution of movement patterns.
Fascia provides a gliding and sliding environment for muscles. Any disturbance in the gliding and sliding ability of fascia could alter movement patterns and result in an abnormal transmission of forces in muscles. This can lead to compensatory movement patterns which over time, can contribute to pain and dysfunction and further injury in any part of the human body. Langevin et al. (2009 and 2011) found a 25% increase in fascial thickness in the lumbar region in a group of chronic low back pain patients compared with those without low back pain by using ultrasound imaging. In a follow up study in 2011 Langevin et al. showed that the fascia shear strain in the lumbar spine was 20% lower in subjects with chronic low back pain affecting connective tissue function. Using similar diagnostic imaging, Stecco et al. (2014) also showed an increase in fascial thickness in the muscles covering the front part of the neck in patients with chronic neck pain compared to a control group.
- Scalenus medius muscle in control subject. (Arrow is fascia)
- Scalenus medius muscle in patient with chronic neck pain. (Arrow is fascia)
Stecco A et al. Surg Radiol Anat (2014) 36:243-253
How Does Fascial Manipulation Work?
Due to (old or more recent) trauma or inflammation, fascia may shorten and what was previously a pain-free range of motion may become painful, restricted and weak. The ability of fascia to allow for gliding and sliding of tissues now has become compromised and so-called densifications of this dysfunctional fascia tissue can be felt. These points of densifications very often are localized and can be felt in areas away from the localization of pain as experienced by the patient.
Once a limited and/or painful movement in this segment has been identified, then a specific point on the fascia is manipulated. By manipulating this specific fascia point for 2-5 minutes the densification in fascia disappears. An improvement in the ability of the fascia to glide and slide allows for normal movement patterns to be restored and pain is reduced. Clinical experience has shown that multiple points in several muscles throughout the body can be affected and need to be treated.
Clinical studies have shown that freeing fascial alerations in these key areas decreases pain, restores movement and muscle strength in patellar tendinopathy (Pedrelli et al. 2009), subacute whiplash disorders (Picelli et al. 2011), chronic ankle sprains (Stecco et al. 2011) and chronic neck pain (Stecco et al. 2014) with long lasting benefits. Ultrasonic imaging also showed a decrease in the thickness of loose connective tissue of the deep fascia following Fascial Manipulation persisting 6 months after ending treatment (Stecco 2014).
How Does It Feel?
Dysfunctions in movement patterns, suggesting abnormalities in the function of fascia, are assessed through range of motion and strength testing during a physical therapy evaluation. Densifications within the fascia tissue can be felt through specific palpation. These points are unusually tender to the touch with very often an unusual sharp sensation when compared to other parts of your body. Very often these densifications and tender points can be identified away from the site if of pain. Again, they are very often correlated to dysfunctional movement patterns with loss in range of motion and strength accompanied by pain.
Following a whole body assessment, manipulation of the densified fascial tissues through direct contact with the skin lasting for 2-5 minutes will result in a gradual and significant decrease in local tenderness. Movement patterns are then re-checked to see if the movement has improved and pain has decreased. Patients are informed that the areas being treated can be sore and tender for 24 to 48 hours due to what we think is a local inflammatory response. Palpation of the treated areas during subsequent treatment sessions often reveals a marked decrease in local tenderness as these points don’t feel as dense to touch. Movement patterns and strength are often improved as pain and dysfunction subsides.
Fascial Manipulation as Part of Physical Therapy can Produce Relief of:
- Low Back Pain
- Neck Pain
- Hip Pain
- Knee Pain
- Shoulder Pain
- Foot and Ankle Pain
- TMJ Pain
- Tension Headaches
Ben Grotenhuis, PT, CMTPT, FAAOMPT
Currently one of only a few clinicians in the state of Illinois that has been trained in the evaluation and treatment of the Stecco Method for Fascial Manipulation.
- Stecco, C., et al. (2014). "Investigation of the mechanical properties of the human crural fascia and their possible clinical implications." Surgical and Radiologic Anatomy 36(1): 25-32.
- Luomala, T., et al. (2014). "Case study: Could ultrasound and elastography visualized densified areas inside the deep fascia?" J Bodyw Mov Ther 18(3): 462-468.
- Langevin, H. M., et al. (2009). "Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain." BMC Musculoskelet Disord 10: 151-151.
- Langevin, H. M., et al. (2011). "Reduced thoracolumbar fascia shear strain in human chronic low back pain." BMC Musculoskelet Disord 12: 203.
- Stecco A et al. (2011). “RMI study and clinical correlations of ankle retinacula damage and outcomes of ankle sprains.“ Surg Radiol Anat 33(10): 881-90
- Stecco, A., et al. (2014). "Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up." Surg Radiol Anat 36(3): 243-253.
- Pedrelli, A., et al. (2009). "Treating patellar tendinopathy with Fascial Manipulation." J Bodyw Mov Ther 13(1): 73-80.
- Picelli, A., et al. (2011). "Effects of myofascial technique in patients with subacute whiplash associated disorders: a pilot study." Eur J Phys Rehabil Med 47(4): 561-568.